Conversations with ... James L. Madara, MD

GEORGE LUNDBERG, MD: Hello, and welcome. I'm Dr. George Lundberg, Editor At Large for MedPage Today, and we are in Chicago at the annual meeting of the American Medical Association, having a conversation with Dr. James Madara, who is the EVP and the CEO of the AMA.

JAMES MADARA, MD: Glad to be with you.

LUNDBERG: Thank you for being with us today; I appreciate that. We met about a year ago at this same hotel when you were about to start as the CEO of the AMA, and you're still around. How's the year been?

MADARA: It's been a great year for promoting the art and science of medicine and the betterment of public health, our mission statement, and we have a lot to show ...

LUNDBERG: That's the mission statement of the AMA. Say that again.

MADARA: It is to promote the art and science of medicine and the betterment of public health.

LUNDBERG: Now, a lot of people think that the AMA is the trade association that represents its members or doctors as its principal element, and yet the mission doesn't say anything about that. How does that work?

MADARA: That's correct. We are an organization, the largest physician organization in the United States, but we have activities that are really strong in the mission areas of research and education. And we also want to promote practice environments that are thriving for physicians. But for those to thrive, they also have to be practices that provide, you know, quality and value as an output.

LUNDBERG: So it should all go together is what you're saying.

MADARA: Absolutely.

LUNDBERG: OK. What are the high points of your first year here?

MADARA: Well, there have been many. So just to name a few, the membership has increased for the first time in many years.

LUNDBERG: Numerically, or percentage-wise, or both?

MADARA: Numerically and percentage-wise -- both.

LUNDBERG: OK.

MADARA: We also are on track this year, although we won't know the numbers for another few months.

We moved an IT platform to service physicians to a nationally scalable effort, partnering with AT&T.

We won a $200 million settlement with United Health that we've redistributed to American physicians.

But I think probably best of all is we've defined and have approved by the board our relatively first long-term strategic plan for the organization, which brings focus and impact.

MADARA: Well, the strategic plan would be a rolling 5-year plan. It has three focus areas dealing with the mission elements. The three focus areas all share a commitment to outcomes as opposed to process.

In the first instance, to develop an outcomes set for improving the nation's health, an outcomes set that is a dashboard of no more than seven to 10 elements that capture a broad swath of disease burden in the United States, and have layered around it our work in public health, ethics, disparities, and the like.

The second focus area is undergraduate medical education. We have upgraded our curricula constantly, but the structure of the curriculum is essentially the same as it was 50 years ago.

LUNDBERG: You're speaking of medical school curricula, or residency curricula, or both?

MADARA: Medical school curricula. And we would hope that this would form a wave, but forward into residency curricula as well.

LUNDBERG: And you, of course, were Dean in the School of Medicine at the University of Chicago for a number of years prior to coming to this job.

MADARA: I was. And some of the changes that we will focus on are going from a time-in-chair curriculum to a competency-based curriculum and thinking about preparing physicians for the new realities of team-based, patient-centered care.

The third focus is in the area of delivery reform, and that area takes into account the fact that we need American physicians to feel that they're satisfied in their practices. We know that physician satisfaction yields patient satisfaction, better outcomes.

And we also know that physician satisfaction will be needed to attract the next generation of the brightest into our field.

LUNDBERG: We also know that a lot of American physicians are not happy, they're not satisfied, they're angry at a whole bunch of things, a lot of which I think has to do with uncertainty. But one of the good things, in my view, about American medicine always is the number of people applying to go to medical school. I mean so many doctors tell me that they don't think their kids should go to medical school. So what happened? Their kids apply to go to medical school, and they're very happy when they get accepted. So that kind of rebirth, rejuvenation, has been there a long time and is still there.

Any final words for our viewers? I mean you look pretty upbeat. Do you feel pretty good?

MADARA: I'm really upbeat. I think we have a bright future. You know, we've been through a lot of difficult things in the 165 years of the AMA's existence, and we've always come out of it looking good. We will come out of this looking very good by focusing on these three mission areas and having the impact that support our patients and American physicians and improve the health of our society.

LUNDBERG: OK. Thank you very much, Dr. James Madara, the CEO of the AMA, for being with us this morning, and thank you for watching. I'm Dr. George Lundberg, Editor at Large for MedPage Today.

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